pegfilgrastim
Pharmacologic class: Granulocytic colony stimulating factor
Action
Binds to specific cell-surface receptors on hematopoietic cells, stimulating their proliferation and differentiation in bone marrow
Availability
Injection: 6 mg/0.6 ml in prefilled syringes
Indications and dosages
➣ To reduce risk of infection in non-myeloid cancer patients who are receiving myelosuppressive drugs
Adults: 6 mg subcutaneously as a single dose once per chemotherapy cycle
Contraindications
• Hypersensitivity to drug, Escherichia coli-derived proteins, filgrastim, or other drug components
Precautions
Use cautiously in:
• myeloid cancers, sickle cell disease
• patients undergoing chemotherapy or radiation
• pregnant or breastfeeding patients
• children (safety and efficacy not established).
Administration
• Inspect solution for particles; discard if particles or discoloration appear.
• Don't give 14 days before to 24 hours after administration of cytotoxic chemotherapy.
Adverse reactions
CNS: headache, weakness, fatigue, dizziness, insomnia
CV: peripheral edema
GI: nausea, vomiting, diarrhea, abdominal pain, dyspepsia, stomatitis, splenic rupture
Hematologic: leukocytosis, granulo-cytopenia
Musculoskeletal: bone pain, myalgia, joint pain
Respiratory: adult respiratory distress syndrome (ARDS) in septic patients
Skin: alopecia, mucositis
Other: taste perversion, allergic reaction, increased pain, fever, neutropenic fever, aggravation of sickle cell disease
Interactions
Drug-drug. Lithium: potentiation of neutrophil release
Drug-diagnostic tests. Alkaline phosphatase, lactate dehydrogenase, uric acid: increased levels
Patient monitoring
☞ Assess for signs and symptoms of impending splenic rupture, such as left upper abdominal quadrant or shoulder pain and splenic enlargement.
• Monitor vital signs and temperature.
☞ Watch for signs and symptoms of sepsis, ARDS, and neutropenic fever.
• Monitor CBC, uric acid level, and liver function tests.
Patient teaching
• Teach patient or caregiver how to administer injection and dispose of syringes at home, if appropriate.
☞ Teach patient to recognize and immediately report respiratory distress or signs and symptoms of splenic rupture.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.
• Instruct patient to have follow-up laboratory tests as needed.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.